Provider Demographics
NPI:1710146238
Name:STROM, ERIC W (COTA L)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:W
Last Name:STROM
Suffix:
Gender:M
Credentials:COTA L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 SAGE ST
Mailing Address - Street 2:
Mailing Address - City:ROCK SPRINGS
Mailing Address - State:WY
Mailing Address - Zip Code:82901-7478
Mailing Address - Country:US
Mailing Address - Phone:307-362-2877
Mailing Address - Fax:
Practice Address - Street 1:1325 SAGE STREET
Practice Address - Street 2:
Practice Address - City:ROCK SPRINGS
Practice Address - State:WA
Practice Address - Zip Code:82901
Practice Address - Country:US
Practice Address - Phone:307-362-2877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY534224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant